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Twimukye A, Alhassan Y, Ringwald B, Malaba T, Myer L, Waitt C, Lamorde M, Reynolds H, Khoo S, Taegtmeyer M. Support, not blame: safe partner disclosure among women diagnosed with HIV late in pregnancy in South Africa and Uganda. AIDS Res Ther 2024; 21:14. [PMID: 38481233 PMCID: PMC10938717 DOI: 10.1186/s12981-024-00600-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND HIV partner disclosure rates remain low among pregnant women living with HIV in many African countries despite potential benefits for women and their families. Partner disclosure can trigger negative responses like blame, violence, and separation. Women diagnosed with HIV late in pregnancy have limited time to prepare for partner disclosure. We sought to understand challenges around partner disclosure and non-disclosure faced by women diagnosed with HIV late in pregnancy in South Africa and Uganda and to explore pathways to safe partner disclosure. METHODS We conducted in-depth interviews and focus group discussions with pregnant women and lactating mothers living with HIV (n = 109), disaggregated by antenatal care (ANC) initiation before and after 20 weeks of gestation, male partners (n = 87), and health workers (n = 53). All participants were recruited from DolPHIN2 trial sites in Kampala (Uganda) and Gugulethu (South Africa). Topic guides explored barriers to partner disclosure, effects of non-disclosure, strategies for safe disclosure. Using the framework analysis approach, we coded and summarised data based on a socio-ecological model, topic guides, and emerging issues from the data. Data was analysed in NVivo software. RESULTS Our findings illustrate pregnant women who initiate ANC late experience many difficulties which are compounded by the late HIV diagnosis. Various individual, interpersonal, community, and health system factors complicate partner disclosure among these women. They postpone or decide against partner disclosure mainly for own and baby's safety. Women experience stress and poor mental health because of non-disclosure while demonstrating agency and resilience. We found many similarities and some differences around preferred approaches to safe partner disclosure among female and male participants across countries. Women and male partners preferred healthcare workers to assist with disclosure by identifying the 'right' time to disclose, mentoring women to enhance their confidence and communication skills, and providing professional mediation for partner disclosure and couple testing. Increasing the number of counsellors and training them on safe partner disclosure was deemed necessary for strengthening local health services to improve safe partner disclosure. CONCLUSION HIV diagnosis late in pregnancy amplifies existing difficulties among pregnant women. Late ANC initiation is an indicator for the likelihood that a pregnant woman is highly vulnerable and needs safeguarding. Respective health programmes should be prepared to offer women initiating ANC late in pregnancy additional support and referral to complementary programmes to achieve safe partner disclosure and good health.
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Affiliation(s)
- Adelline Twimukye
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yussif Alhassan
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Beate Ringwald
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thokozile Malaba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Catriona Waitt
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Mohammed Lamorde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Helen Reynolds
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Saye Khoo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Tropical Infectious Disease Unit, Liverpool University Hospital Foundation Trust, Liverpool, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Tropical Infectious Disease Unit, Liverpool University Hospital Foundation Trust, Liverpool, UK
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Mmotsa TM, Magasana V, Nsibande DF, Buthelezi M, Dassaye R, Rodriguez VJ, Jones DL, Goga AE, Ngandu NK. Mixed-methods cross-sectional study of the prevention of vertical HIV transmission program users unaware of male partner's HIV status, in six South African districts with a high antenatal HIV burden. BMC Public Health 2023; 23:1988. [PMID: 37828512 PMCID: PMC10571358 DOI: 10.1186/s12889-023-16921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Elimination of vertical HIV Transmission (VHT) and maternal deaths are global health priorities. Male involvement is one of the most important factors that influences women's decisions, including the uptake of Prevention of vertical HIV transmission (P-VHT). We sought to understand not knowing a male partner's HIV status (MPHIVs) amongst women using services to prevent vertical HIV transmission in six South African districts with high antenatal HIV burden. METHODS A mixed-methods cross-sectional study was conducted in six South African districts, and data collected through face-to-face interviews with women and focus group discussions (FGDs) with women or male partners. The quantitative data were analyzed using STATA SE-17.0 and an inductive approach was used for qualitative data analysis. RESULTS Overall, 28.7% of women were unaware of their MPHIVs, while 25.3% and 46.0% knew the MPHIVs was positive or negative, respectively. In multivariable logistic regression, single marital status and unplanned pregnancy increased the odds of not knowing a MPHIVs while a woman's disclosure of her HIV status to the male partner reduced the odds. FDGs highlighted complexities around MPHIVs disclosure, e.g., reluctance to test for HIV and potential interventions including healthcare worker (HCW) assisted HIV disclosure. CONCLUSION User-informed interventions to address MPHIVs non-disclosure amongst women of child-bearing age, particularly those at risk of unstable sexual partners and unplanned pregnancies, should be strengthened.
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Affiliation(s)
- Tshiamo M Mmotsa
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Vuyolwethu Magasana
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Duduzile F Nsibande
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mbongeleni Buthelezi
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Reshmi Dassaye
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology (Clinical/Community Division), University of Illinois at Urbana-Champaign, Champaign, IL, United States of America
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ameena E Goga
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Nobubelo K Ngandu
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
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Miller AP, Pitpitan EV, Kiene SM, Raj A, Jain S, Zúñiga ML, Nabulaku D, Nalugoda F, Ssekubugu R, Nantume B, Kigozi G, Sewankambo NK, Kagaayi J, Reynolds SJ, Wawer M, Wagman JA. In the era of universal test and treat in Uganda, recent intimate partner violence is not associated with subsequent ART use or viral suppression. AIDS Care 2023; 35:1291-1298. [PMID: 37170392 PMCID: PMC10524228 DOI: 10.1080/09540121.2023.2206092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Abstract
Intimate partner violence (IPV) has been associated with delays throughout the HIV care continuum. This study explored prospective associations between experiences of past-year IPV and two HIV care outcomes in the context of current universal test and treat guidelines using two consecutive rounds of an ongoing HIV surveillance study conducted in the Rakai region of Uganda. Longitudinal logistic regression models examined associations between IPV, use of antiretroviral therapy (ART) and viral load suppression (VS), adjusting for outcome variables at baseline. To address differences in ART retention by IPV, propensity scores were used to create inverse-probability-of-treatment-and-censoring-weighted (IPTCW) models. At baseline, of 1923 women with HIV (WWH), 34.6%, 26.5%, 13.5% reported past-year verbal, physical and sexual IPV; a lower proportion of persons who experienced physical IPV (79.4%) were VS than those who did not (84.3%; p = 0.01). The proportion VS at baseline also significantly differed by exposure to verbal IPV (p = 0.03). However, in adjusted longitudinal models, IPV was not associated with lower odds of ART use or VS at follow-up. Among WWH in the Rakai region, IPV does not appear to be a barrier to subsequent ART use or VS. However, given the prevalence of IPV in this population, interventions are needed.
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Affiliation(s)
- Amanda P Miller
- Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Eileen V Pitpitan
- San Diego State University School of Social Work, San Diego, CA, USA
| | - Susan M Kiene
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Anita Raj
- Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | | | | | - Nelson K Sewankambo
- Rakai Health Sciences Program, Entebbe, Uganda
- Makerere University School of Medicine, Kampala, Uganda
| | | | - Steven J Reynolds
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria Wawer
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer A Wagman
- Department of Community Health Sciences, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
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Tessema BT, Bune GT, Mamo ZB. Non-Disclosure of HIV-Positive Serostatus: Unmatched Case-Control Study in People Living with HIV in Public Health Facilities of Gedeo Zone, Southern Ethiopia. HIV AIDS (Auckl) 2023; 15:313-324. [PMID: 37323770 PMCID: PMC10263022 DOI: 10.2147/hiv.s405818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023] Open
Abstract
Background Non-disclosure of HIV-positive status (NDHPSS) is the individual's experience of hiding their HIV status from other people or groups. People who fail to reveal their HIV-positive serostatus risk contracting the virus again, not receiving the best possible care, and even dying. Purpose To assess predictors of NDHPSS in people living with HIV in public health facilities in Gedeo-Zone, Southern-Ethiopia. Methods In Gedeo-Zone, Southern Ethiopia, a facility-based, unmatched, case-control study was carried out from the first of February to March 30, 2022GC. With a case-to-control ratio of 1:1, a total of 360 respondents (89 cases and 271 controls) were involved. The respondents were chosen using a sequential sampling technique. EpiData-V-3.1 was used to enter the data, and SPSS-V-25 was used to analyse it. To determine the factors that were connected to the result, a binary logistic regression analysis was performed. AOR at the 95% confidence interval and p-values under 0.05 were utilised to explain their statistical significance. Results The study had 360 participants in total-271 controls and 89 cases-resulting in a response rate of 97.6%. The average age of the participants was 35.6 years (SD: 8.3). After adjusting the possible confounders, sex (AOR = 2.8, 95% CI: 1.04-7.56), residence (AORs = 3.52, 95% CI: 2.83-9.39), WHO clinical stage I (AORs = 4.68, 95% CI: 1.9-22.1), short duration of ART follow-up care (AOR = 4.21, 95% CI: 1.65-10.73), and number of lifetime sexual partners (AOR = 6.9, 95% CI: 1.86-26.3) were significantly associated factors with the outcome. Conclusion According to this study, living in a rural area and being in WHO clinical stage one, in addition to being a woman and having multiple sexual partners during one's lifetime, were predictors of non-disclosure of an HIV-positive serostatus. As a result, encouraging people with HIV in WHO stage I and those who have had more than one sexual partner in their lifetime to disclose their status and expanding counselling services for rural residents and women have a substantial impact on reducing the HIV load.
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Affiliation(s)
- Betelhem Tadesse Tessema
- Reproductive Health, School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Girma Tenkolu Bune
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Zerihun Berhanu Mamo
- Reproductive Health, School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Okorie CN, Gutin SA, Getahun M, Lebu SA, Okiring J, Neilands TB, Ssali S, Cohen CR, Maeri I, Eyul P, Bukusi EA, Charlebois ED, Camlin CS. Sex specific differences in HIV status disclosure and care engagement among people living with HIV in rural communities in Kenya and Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000556. [PMID: 37027350 PMCID: PMC10081749 DOI: 10.1371/journal.pgph.0000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023]
Abstract
Non-disclosure of human immunodeficiency virus (HIV) status can hinder optimal health outcomes for people living with HIV (PLHIV). We sought to explore experiences with and correlates of disclosure among PLHIV participating in a study of population mobility. Survey data were collected from 1081 PLHIV from 2015-16 in 12 communities in Kenya and Uganda participating in a test-and-treat trial (SEARCH, NCT#01864603). Pooled and sex-stratified multiple logistic regression models examined associations of disclosure with risk behaviors controlling for covariates and community clustering. At baseline, 91.0% (n = 984) of PLHIV had disclosed their serostatus. Amongst those who had never disclosed, 31% feared abandonment (47.4% men vs. 15.0% women; p = 0.005). Non-disclosure was associated with no condom use in the past 6 months (aOR = 2.44; 95%CI, 1.40-4.25) and with lower odds of receiving care (aOR = 0.8; 95%CI, 0.04-0.17). Unmarried versus married men had higher odds of non- disclosure (aOR = 4.65, 95%CI, 1.32-16.35) and no condom use in the past 6 months (aOR = 4.80, 95%CI, 1.74-13.20), as well as lower odds of receiving HIV care (aOR = 0.15; 95%CI, 0.04-50 0.49). Unmarried versus married women had higher odds of non-disclosure (aOR = 3.14, 95%CI, 1.47-6.73) and lower odds of receiving HIV care if they had never disclosed (aOR = 0.05, 95%CI, 0.02-0.14). Findings highlight gender differences in barriers to HIV disclosure, use of condoms, and engagement in HIV care. Interventions focused on differing disclosure support needs for women and men are needed and may help facilitate better care engagement for men and women and improve condom use in men.
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Affiliation(s)
- Chinomnso N. Okorie
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Sarah A. Gutin
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Sarah A. Lebu
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Torsten B. Neilands
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
| | - Sarah Ssali
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Irene Maeri
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Patrick Eyul
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Elizabeth A. Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Edwin D. Charlebois
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
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Tibebu NS, Rade BK, Kebede AA, Kassie BA. Disclosure of HIV status to sexual partner and its associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional state Referral Hospitals, Ethiopia. PLoS One 2023; 18:e0280045. [PMID: 36649277 PMCID: PMC9844863 DOI: 10.1371/journal.pone.0280045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Disclosure of Human Immunodeficiency Virus (HIV) status to sexual partners plays a significant role in the successful prevention and care of HIV infection. Pregnant women who did not reveal their HIV status to their sexual partners make the prevention and control efforts challenging. Therefore, this study was aimed to assess HIV status disclosure to sexual partners and associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional state referral Hospitals, Ethiopia in 2021. METHODS An institution-based cross-sectional study was conducted from October 17th, 2020 to March 1st, 2021. A total of 423 pregnant women living with HIV were participated in this study. A systematic random sampling technique was used to select all eligible women. Data was collected using a semi-structured, pretested, and interviewer-administered questionnaire. EPI INFO version 7 and SPSS version 21 were used for data entry and analysis, respectively. Both univariable and multivariable logistic regression analyses were performed to find factors associated with women's disclosure status to a sexual partner. Statistical association was decided based on the adjusted odds ratio (AOR) with its 95% Confidence Interval (CI) and p-value of ≤ 0.05. RESULTS The prevalence of disclosure of their HIV status to their sexual partners was 73% (95% CI: 68.9%, 77.3%). Being an urban resident (AOR = 5.04, 95% CI: 2.14, 11.81), diagnosed HIV before pregnancy (AOR = 7.77, 95% CI: 3.09, 19.52), disclosing their HIV status to others (AOR = 7.01, 95% CI: 3.78, 13.25), planned pregnancy (AOR = 2.46, 95% CI: 1.32, 4.57), and having good knowledge on HIV/AIDS prevention (AOR = 2.19, 95% CI:1.22, 3.94) were found to be statistically significant with women's disclosure of their HIV status to their sexual partner. CONCLUSION In this study, nearly three-fourth of pregnant women disclosed their HIV status to their sexual partner. Thus, setting strategies in preventing unplanned pregnancy, HIV diagnosed before pregnancy, and increasing knowledge of HIV prevention will have significant role in escalating women's disclosure status.
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Affiliation(s)
- Nebiyu Solomon Tibebu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Bayew Kelkay Rade
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Ayanaw Kassie
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mosisa G, Mulisa D, Oluma A, Bayisa L, Merdassa E, Bayisa D, Tamiru A, Tolossa T, Chala Diriba D, Fetensa G, Wakuma B. HIV sero-status disclosure and associated factors among HIV positive women in East Africa: Systematic review and meta-analysis. Implications for prevention of mother-to-child HIV transmission. Front Public Health 2022; 10:919410. [PMID: 36483255 PMCID: PMC9723243 DOI: 10.3389/fpubh.2022.919410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Women's HIV-positive disclosure plays a pivotal role to achieve the goal of preventing mother-to-child transmission (PMTCT) among pregnant women in particular. Although several primary studies were conducted in the different countries of East Africa, no study concluded the prevalence of women's HIV status disclosure and associated factors in East Africa. Therefore, the current study aimed to assess the pooled prevalence of disclosure status and associated factors among women in East Africa. Objectives To assess the pooled prevalence of HIV sero-status disclosure and associated factors among women in East Africa. Methods HINARI, PubMed, and Cochrane Library databases were searched. The data were extracted using a Microsoft Excel spreadsheet and STATA v 14.1 was used for the analysis. The Funnel plots and Egger's statistical test was used to check publication bias. Heterogeneity was assessed by conducting sensitivity and subgroup analyses. Result The pooled prevalence of sero-status disclosure among women in East Africa was 73.77% (95%CI 67.76, 79.77). Knowing partner's sero-status (OR = 10.04(95%CI 3.36, 31.84), married (OR = 2.46 (95%CI 1.23, 4.89), smooth relationship (OR = 3.30 (95%CI 1.39, 7.84), and discussion on HIV before the test (OR = 6.96 (95%CI 3.21, 15.05) were identified determinants of HIV sero-status disclosure. Conclusion The current systematic and meta-analysis revealed that nearly one-fourth of women had not disclosed HIV sero-status to at least one individual. Knowing the partner's HIV sero-status, being married, having a smooth relationship, and discussing on HIV before the test were determinants of disclosure status. Therefore, disclosure of HIV-positive sero-status among women living with HIV needs to be strengthened.
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Affiliation(s)
- Getu Mosisa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia,*Correspondence: Getu Mosisa
| | - Diriba Mulisa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Adugna Oluma
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Lami Bayisa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Emiru Merdassa
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Bayisa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Afework Tamiru
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia,Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Dereje Chala Diriba
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getahun Fetensa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
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Mkandawire AK, Jumbe V, Nyondo-Mipando AL. To disclose or not: experiences of HIV infected pregnant women in disclosing their HIV status to their male sexual partners in Blantyre, Malawi. BMC Public Health 2022; 22:1552. [PMID: 35971103 PMCID: PMC9377067 DOI: 10.1186/s12889-022-13974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background HIV status disclosure is one of the pillars of success of the elimination of Mother to Child Transmission of HIV (eMTCT) program. However, there are challenges associated with it that limit full disclosure. Literature shows that for pregnant women in developing countries, who have been diagnosed with HIV, 16% to 86% disclose their status to their sexual partners. This study explored the experiences of newly diagnosed HIV-infected antenatal women in disclosing their HIV status to their male sexual partners in Blantyre, Malawi. Methods This was a qualitative explanatory multiple case study that was conducted from 2018 to 2019 using in-depth interviews and diaries as data collection tools. We recruited seven newly diagnosed HIV pregnant women who had not disclosed their status to their male sexual partners and were initiated on Option B + strategy of the eMTCT of HIV at Limbe Health Centre. The investigator had 3 contacts with each participant from which data was gathered except for one participant who got lost to follow-up. This study employed content analysis and used a within-case and across-case analysis. Results Women either use facilitated mutual disclosure process or disclosed directly to their male sexual partners. Women were motivated to disclose because they wanted an HIV-free baby, to know the partners' status, and to resolve the gap on how they got infected with HIV. The disclosure process faced challenges such as uncertainty about a partner’s reaction after disclosure, fear of relationship dissolution, and the soberness of the partner. Privacy was an important consideration during the process of disclosure. Following disclosure, male sexual partners either accepted the status immediately after disclosure or initially denied but later accepted. Conclusion This study has shown that newly diagnosed HIV pregnant women accessing eMTCT services have a plan of either to disclose or conceal their HIV status from their male sexual partner and this decision is affected by the nature of relationship that exist between them and their partner. Factors relating to the unborn baby, the relationship as well as to know partners status motivate women to either disclose or conceal.
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Affiliation(s)
- Annie Kalibwe Mkandawire
- Department of Health Systems and Policy, School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi. .,Malawi College of Health Sciences, Blantyre, Malawi.
| | - Vincent Jumbe
- Department of Health Systems and Policy, School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
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Intimate partner violence and oral HIV pre-exposure prophylaxis adherence among young African women. AIDS 2022; 36:1151-1159. [PMID: 35579012 PMCID: PMC9486991 DOI: 10.1097/qad.0000000000003216] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the effect of intimate partner violence (IPV) on oral PrEP adherence among adolescent girls and young women (AGYW). DESIGN We conducted a secondary analysis of data from HIV Prevention Trials Network 082 (HPTN 082), a multisite prospective study designed to assess oral PrEP adherence among AGYW in southern Africa. METHODS We estimated the relative prevalence of high PrEP adherence 3 and 6 months after initiation among AGYW 16-25 years who reported a history of any IPV in the past year at enrollment versus AGYW who did not, both overall and by age. High adherence was defined as an intracellular tenofovir-diphosphate concentration at least 700 fmol/punch in dried blood spots. RESULTS Among 409 PrEP-initiating AGYW, half (49%) reported experiencing any IPV by a current/recent partner in the year prior to enrollment. Overall, a similar proportion of AGYW who reported IPV had high PrEP adherence at months 3 and 6 as AGYW who did not report IPV. There was, however, evidence of effect modification by age at month 3: among AGYW less than 21 years, those who reported IPV were less than half as likely to have high adherence [adjusted PR (aPR) = 0.43, 95% confidence interval (CI) 0.22-0.86]; among AGYW aged 21 years, those who reported IPV were more than twice as likely to have high adherence (aPR = 2.21, 95% CI 1.34-3.66). At month 6, effect estimates within each age stratum were consistent in direction to those at month 3. CONCLUSION IPV events may either impede or motivate PrEP adherence among African AGYW, with age appearing to be an important consideration for IPV-related adherence interventions.
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10
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Miller AP, Ddaaki WG, Bloom BE, Wirtz AL, Nakyanjo N, Kigozi G, Wagman JA. Perspectives of Women Living With HIV on Addressing Violence and Use of Alcohol During HIV Services: Qualitative Findings From Fishing Communities in Uganda. Violence Against Women 2022; 28:1483-1504. [PMID: 34139908 PMCID: PMC8678385 DOI: 10.1177/10778012211019054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The syndemic relationship between harmful alcohol use, intimate partner violence (IPV), and HIV is well established across international settings. Less is known about how these health issues are perceived by women living with HIV (WLWH), who are disproportionately affected by these intertwined epidemics. A qualitative study was undertaken with 20 WLWH in Rakai, Uganda, to assess their perceptions of how these issues have affected their lives and their communities and to assess the acceptability of integrating a screening and brief intervention for alcohol use and IPV into HIV posttest counseling. Recommendations for intervention programming arising from the results are discussed.
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Affiliation(s)
| | - William G. Ddaaki
- Rakai Health Sciences Program, Kalisizo, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Neema Nakyanjo
- Rakai Health Sciences Program, Kalisizo, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
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11
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Pashaei Z, Oskouie F, Moradi-Lakeh M, Jahanfar S, Haghani S. HIV serostatus disclosure to sexual partner: a survey among women in Tehran, Iran. Eur J Med Res 2022; 27:56. [PMID: 35395935 PMCID: PMC8994217 DOI: 10.1186/s40001-022-00663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disclosure of HIV-positive status in women is associated with many factors. Consequently, status disclosure remains a challenge for Iranian women living with HIV. This study aimed to assess the prevalence, related factors, and reflections of HIV-positive status disclosure to a sexual partner(s) among Iranian women living with HIV. METHODS A cross-sectional study was conducted on 170 HIV-seropositive women. Participants were selected from patients registered in the largest HIV clinic and HIV-positive club of Iran. The "HIV disclosure" questionnaire had 38-items and all the interviews were administered by the researcher. Data were analyzed using SPSS version 21.0 software. We used a logistic regression method to calculate the crude odds ratio (COR) and the adjusted odds ratio (AOR) for self-disclosure as the independent predictor variable and the dependent variable, respectively. RESULTS One hundred and seventy HIV-positive women were enrolled. Most of them had disclosed their HIV status to at least one person (94.1%) and their sexual partners (86.5%). In the univariate analysis, being married (COR = 18.66, 95% CI 5.63-61.87), living with a sexual partner (COR = 4.72, 95% CI 1.92-11.62), being aware of sexual partners' HIV status (COR = 6.20, 95% CI 1.79-21.49), and gaining the support of sexual partner (COR = 9.08, 95% CI 3.48-23.64) were associated with higher odds of HIV status disclosure. In the multivariate analysis, being aware of sexual partners' HIV status, and gaining the support of sexual partners remained associated with HIV status disclosure. Most women reported a positive reflection from their sexual partners after disclosure, however, negative reflections from society were more common compared to sexual partners and family members. CONCLUSION This study shows high overall HIV disclosure proportions. It should be noted that a large number of women were infected by their sexual partners, especially by their spouses. The high rate of transmission in married people indicates an urgent need for more emphasis on appropriate prevention behaviors by infected partners.
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Affiliation(s)
- Zahra Pashaei
- Department of Community Health Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.,Iranian Research Center for HIV/AIDS (IRCHA), Iran Nursing Care, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Oskouie
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran. .,Department of Community Health Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA
| | - Shima Haghani
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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12
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Mmotsa TM, Ngandu NK, Adetokunboh OO, Nyasulu P. Male partner unknown HIV status as a risk factor for HIV incidence and clinical outcomes in prevention of mother-to-child transmission of HIV programmes in 21 WHO priority countries: a systematic review protocol. BMJ Open 2022; 12:e057190. [PMID: 35393320 PMCID: PMC8990715 DOI: 10.1136/bmjopen-2021-057190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Research has shown an association between increased disclosure of HIV status by pregnant and breastfeeding women and improved clinical health and that of their infant. Increasing awareness about their male partner's HIV status will no doubt lead to even better outcomes at the population level. Male partner involvement is important for improving outcomes of prevention of mother-to-child transmission of HIV (MTCT) as it improves social support and commitment from both parents of the baby to ensure sustained good health. Although lack of knowledge of the HIV status of a male partner is of great concern, limited research has been done to determine whether it remains one of the barriers to reaching the proposed goals of eliminating MTCT in pregnant or postpartum women. Our aim is to determine if lack of knowledge of a male partner's HIV status is a significant risk factor for HIV incidence and poor HIV clinical outcomes among pregnant women and postpartum women and their infants. METHODS AND ANALYSIS A systematic review and meta-analysis of experimental and observational studies will be conducted. The review will focus on knowledge of male partner's HIV status in the 21 priority countries most affected by HIV in Africa. We will search electronic databases such as PubMed/Medline, Scopus, Web of Science and Cochrane library, Science Direct, CINAHL, LILACS and SciELO databases from January 2011 to December 2021. We will also search the Pan African and WHO clinical trial registries and conference archives. We will conduct a quality assessment of eligible studies and evaluate the heterogeneity of the pooled studies using the I 2 statistic. The statistical analysis will be performed using STATA statistical software V.16. ETHICS AND DISSEMINATION The study will use publicly available data and ethics exemption has been obtained from Human Research Ethics Committees, Faculty of Medicine & Health Sciences, Stellenbosch University. The protocol was registered on Prospective Register of Systematic Reviews, registration number CRD42021247686, in May 2021. Findings of this systematic review will be disseminated in peer-review journals including various media platforms, that is, webinars, symposia, conferences or congresses. PROSPERO REGISTRATION NUMBER Registration number CRD42021247686.
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Affiliation(s)
| | - Nobubelo Kwanele Ngandu
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Olatunji O Adetokunboh
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Division of Epidemiology and Biostatistics, Stellenbosch University, Stellenbosch, South Africa
- The University of the People, Pasadena, California, USA
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Stellenbosch University, Stellenbosch, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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13
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Zotova N, Familiar I, Kawende B, Kasindi FL, Ravelomanana N, Parcesepe AM, Adedimeji A, Lancaster KE, Kaba D, Babakazo P, Yotebieng M. HIV disclosure and depressive symptoms among pregnant women living with HIV: a cross‐sectional study in the Democratic Republic of Congo. J Int AIDS Soc 2022; 25:e25865. [PMID: 35129301 PMCID: PMC8819634 DOI: 10.1002/jia2.25865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/14/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction Methods Results Conclusions
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Affiliation(s)
- Natalia Zotova
- Division of General Internal MedicineDepartment of MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Itziar Familiar
- Department of PsychiatryMichigan State UniversityEast LansingMichiganUSA
| | - Bienvenu Kawende
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | | | - Noro Ravelomanana
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | - Angela M. Parcesepe
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Adebola Adedimeji
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Kathryn E. Lancaster
- Division of Epidemiology, College of Public HealthOhio State UniversityColumbusOhioUSA
| | - Didine Kaba
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | - Pélagie Babakazo
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | - Marcel Yotebieng
- Division of General Internal MedicineDepartment of MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
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14
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Yonga AM, Kiss L, Onarheim KH. A systematic review of the effects of intimate partner violence on HIV-positive pregnant women in sub-Saharan Africa. BMC Public Health 2022; 22:220. [PMID: 35114964 PMCID: PMC8815228 DOI: 10.1186/s12889-022-12619-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background Intimate partner violence (IPV) affects more than one in three women in sub-Saharan Africa (SSA). It is associated with both pregnancy and HIV, adversely affecting women in this region. This is the first systematic examination of the effects of IPV on HIV-positive (HIV+) pregnant women in SSA. Methods A systematic review of the literature on HIV+ pregnant women experiencing IPV in SSA was carried out. Searches were carried out in PubMed, Web of Science and African Journals Online databases. Articles published between January 2010 and June 2020, in English, were included. Data extraction included details on study locations, study design, study participants and the study outcome variables (depression, IPV, medication adherence, postpartum unsafe sex, and HIV disclosure). Results Fourteen studies (ten cross-sectional studies, four cohort studies) were included. Results indicate a high prevalence of IPV amongst pregnant women with HIV in SSA (18.0 to 63.1%). The results suggest an association between HIV-positive status and consequences of IPV during pregnancy, particularly mental health effects, such as depression symptoms and suicidal ideation. HIV-related stigma has a key role within the relationship between HIV and IPV during pregnancy. One study described that the presence of IPV reduces adherence to Prevention of Mother-To-Child Transmission (PMTCT) medication. Three studies reported no association between HIV positive status or HIV status disclosure and IPV during pregnancy. Discussion/conclusions The systematic review confirms interconnections between IPV and HIV seropositivity amongst pregnant women in SSA. Importantly, stigma, social isolation and poor mental health hinder help-seeking, disclosure, and treatment adherence among HIV+ pregnant women exposed to IPV in SSA. As a result, the potential of community interventions to tackle issues associated with IPV in HIV-positive pregnant women in this area should be explored in research, policy, and practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12619-w.
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Affiliation(s)
| | - Ligia Kiss
- Institute for Global Health, University College London, London, UK.,Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Kristine Husøy Onarheim
- Institute for Global Health, University College London, London, UK.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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15
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Hempel S, Ferguson L, Bolshakova M, Yagyu S, Fu N, Motala A, Gruskin S. Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol. BMJ Open 2021; 11:e053608. [PMID: 34887280 PMCID: PMC8663079 DOI: 10.1136/bmjopen-2021-053608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive. METHODS AND ANALYSIS Building on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common 'critical factors for success or failure' can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma. PROSPERO REGISTRATION NUMBER CRD42021249348.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- Department of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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16
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Nordberg B, Mwangi W, van der Kop ML, Were E, Kaguiri E, Kågesten AE, Gabriel EE, Lester RT, Mwangi J, Ekström AM, Rautiainen S. The effect of weekly interactive text-messaging on early infant HIV testing in Kenya: a randomised controlled trial (WelTel PMTCT). Sci Rep 2021; 11:22652. [PMID: 34811384 PMCID: PMC8609032 DOI: 10.1038/s41598-021-00972-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022] Open
Abstract
Mother-to-child transmission of HIV remains a significant concern in Africa despite earlier progress. Early infant diagnosis (EID) of HIV is crucial to reduce mortality among infected infants through early treatment initiation. However, a large proportion of HIV-exposed infants are still not tested in Kenya. Our objective was to investigate whether weekly interactive text-messages improved prevention of mother-to-child transmission (PMTCT) of HIV care outcomes including EID HIV testing. This multicentre, parallel-group, randomised, open-label trial included six antenatal care clinics across western Kenya. Pregnant women living with HIV, aged 18 years or older, with mobile phone access, were randomised in a 1:1 ratio to weekly text messages that continued until 24 months postpartum, asking “How are you?” (“Mambo?”) to which they were asked to respond within 48 h, or a control group. Healthcare workers contacted participants reporting problems and non-responders by phone. Participants in both groups received routine PMTCT care. The prespecified secondary outcome reported in this paper is EID HIV testing by eight weeks of age (blinded outcome assessment). Final 24-months trial results will be published separately. We estimated risk ratios using Poisson regression with robust standard errors. Between June 2015–July 2016, we screened 735 pregnant women, of whom 600 were enrolled: 299 were allocated to the intervention and 301 to the control group. By eight weeks of age, the uptake of EID HIV testing out of recorded live births was 85.5% in the intervention and 84.7% in the control group (71.2% vs. 71.8% of participants randomised, including miscarriages, stillbirths, etc.). The intention-to-treat risk ratio was 0.99; 95% CI: 0.90–1.10; p = 0.89. The proportion of infants diagnosed with HIV was 0.8% in the intervention and 1.2% in the control group. No adverse events were reported. We found no evidence to support that the WelTel intervention improved EID HIV testing. A higher uptake of EID testing than expected in both groups may be a result of lower barriers to EID testing and improved PMTCT care in western Kenya, including the broader standard use of mobile phone communication between healthcare workers and patients. (ISRCTN No. 98818734. Funded by the European-Developing Countries Clinical Trial Partnership and others).
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Affiliation(s)
- Björn Nordberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. .,Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden.
| | - Winfred Mwangi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Directorate of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Edwin Were
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | | | - Anna E Kågesten
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Erin E Gabriel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Richard T Lester
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Jonathan Mwangi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
| | - Susanne Rautiainen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Division of Preventive Medicine, Brigham and Women's Hospital, Boston, USA
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17
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Finocchario-Kessler S, Brown M, Maloba M, Nazir N, Wexler C, Goggin K, Dariotis JK, Mabachi N, Lagat S, Koech S, Gautney B. A Pilot Study to Evaluate the Impact of the HIV Infant Tracking System (HITSystem 2.0) on Priority Prevention of Mother-to-Child Transmission (PMTCT) Outcomes. AIDS Behav 2021; 25:2419-2429. [PMID: 33709212 PMCID: PMC8224224 DOI: 10.1007/s10461-021-03204-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
We assessed the preliminary impact of the adapted HIV Infant Tracking System (HITSystem v2.0) intervention on prevention of mother-to-child transmission (PMTCT) outcomes using a matched cluster randomized design in two Kenyan government hospitals. Between November 2017 and June 2019, n = 157 pregnant women with HIV were enrolled and followed from their first PMTCT appointment until 12-weeks postpartum. Data from 135 women were analyzed (HITSystem 2.0: n = 53, standard of care (SOC): n = 82), excluding eight deaths, eight pregnancy losses, and six transfers/moves. The primary outcome, complete PMTCT retention, is an aggregate measure of attendance at all scheduled antenatal appointments, hospital-based delivery, and infant HIV-testing before 7-weeks postnatal. HITSystem 2.0 participants were more likely to receive complete PMTCT services compared to SOC (56.6% vs. 17.1% p < 0.001). In multivariate modeling, HITSystem 2.0 was the strongest predictor of complete PMTCT retention (aOR 5.7, [1.2-90.8], p = 0.032). SOC participants had 1.91 increased hazard rate of PMTCT disengagement; (aHR 6.8, [2.2-21.1]; p < 0.001).
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Affiliation(s)
- Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Niaman Nazir
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy, Kansas City, MO, USA
- Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jacinda K Dariotis
- Department of Human Development and Family Studies & Family Resiliency Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | | | - Sharon Koech
- Global Health Innovations, Nairobi, Kenya
- Ministry of Health, Nandi County, Kenya
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18
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Schatz E, David I, Angotti N, Gómez-Olivé FX, Mojola SA. From "Secret" to "Sensitive Issue": Shifting Ideas About HIV Disclosure Among Middle-Aged and Older Rural South Africans in the Era of Antiretroviral Treatment. J Aging Health 2021; 34:14-24. [PMID: 34027688 DOI: 10.1177/08982643211020202] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE As HIV shifts from "death sentence" to "chronic condition," disclosure of HIV status to intimate partners and family is a significant component of both prevention and treatment adherence. While disclosure is closely considered in many studies, few examine middle-aged and older persons' (age 40+) perspectives or practices. We trace older rural South Africans' views on HIV disclosure to their partners and family members in a high prevalence community over a period of extensive antiretroviral treatment (ART) rollout. METHODS Community focus group discussions (FGD) conducted in 2013 and 2018 show shifts in older persons' thinking about HIV disclosure. FINDINGS Our FGD participants saw fewer negative consequences of disclosure in 2018 than in 2013, and highlighted positive outcomes including building trust (partners) as well as greater support for medication collection and adherence (family). DISCUSSION Particularly as the epidemic ages in South Africa and globally, tracing changes in older persons' views on disclosure is an important step in developing messaging that could enhance treatment as prevention and ART adherence.
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Affiliation(s)
- Enid Schatz
- University of Missouri14716, Columbia, MO, USA.,37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Nicole Angotti
- 37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,8363American University, Washington, DC, USA
| | - F Xavier Gómez-Olivé
- 37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanyu A Mojola
- 37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,6740Princeton University, Princeton, NJ, USA
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19
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Adeniyi OV, Nwogwugwu C, Ajayi AI, Lambert J. Barriers to and facilitators of HIV serostatus disclosure to sexual partners among postpartum women living with HIV in South Africa. BMC Public Health 2021; 21:915. [PMID: 33985450 PMCID: PMC8117658 DOI: 10.1186/s12889-021-10955-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background Disclosure of HIV serostatus to a sexual partner can facilitate partner’s support and testing and better treatment outcomes. Studies examining changes in disclosure rates of serostatus from delivery and postpartum periods are scarce. Our study fills this gap by using a follow-up survey of postpartum women with HIV to examine if disclosure prevalence has improved compared to the proportion recorded at childbirth. We further assessed the reasons for non-disclosure and correlates of serostatus disclosure to sexual partners. Methods We conducted a cross-sectional analytical study (exit interview) with a final sample of 485 postpartum women with HIV drawn from the East London Prospective Cohort study database between January and May 2018. Disclosure of HIV status to partner was based on self-reporting. We fitted adjusted and unadjusted logistic regression models and also conducted descriptive statistical analyses. Sampling weights were used to correct for sampling errors. Results Overall, 81.8% of women in the study cohort had disclosed their status to their partners, representing a 7.4 percentage point increase since child delivery. After adjusting for important covariates, women were more likely to disclose their status if they were married [adjusted odds ratio (AOR): 3.10; 95% confidence interval (CI):1.39–6.91] but were less likely to disclose if they used alcohol [AOR: 0.61; 95% CI:0.37–0.99] or had reported adherence to ART [AOR: 0.59; 95% CI:0.36–0.96]. Fear of rejection, stigma or being judged, new or casual relationships, and having a violent partner were the main reasons for not disclosing HIV status to sexual partners. Conclusion We found a relatively higher rate of HIV status disclosure in the cohort compared to the rate recorded at childbirth, suggesting an improvement over time. Also, complicated relationship dynamics and fear of social exclusion still constitute barriers to HIV status disclosure to sexual partners despite patients’ counselling. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10955-x.
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Affiliation(s)
- Oladele Vincent Adeniyi
- Department of Family Medicine & Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha/East London Hospital Complex, Cecilia Makiwane Hospital, East London, South Africa.
| | - Charlotte Nwogwugwu
- Masters in Public Health Program, UMB School of Medicine, University of Maryland School of Nursing, 655 West Lombard St., Room 482, Baltimore, MD, 21201, USA
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya
| | - John Lambert
- Mater Misericordiae University Hospital and University College Dublin School of Medicine, Dublin, Ireland
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20
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Ambissa M, Sendo EG, Assefa Y, Guta A. HIV-positive status disclosure to a sexual partner and associated factors among HIV-positive pregnant women attending antenatal care in Dire Dawa, Ethiopia: A cross-sectional study. PLoS One 2021; 16:e0250637. [PMID: 33905432 PMCID: PMC8078815 DOI: 10.1371/journal.pone.0250637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Pregnant women who disclose their HIV-positive status to their sexual partners have played an important role in reducing the risk of HIV/AIDS transmission to the baby during the antepartum, intrapartum, and postnatal periods. Studies are limited in the current study area in a similar arena. Therefore, this study aimed to assess the proportion of HIV-positive status disclosure and its associated factors among pregnant women. Methods A facility-based cross-sectional study was conducted among 156 HIV-positive pregnant women in Dire Dawa administrative from March 12th to May 10th, 2020. Data were generated using a pretested structured questionnaire through face-to-face interviews. Binary logistic regression analysis was employed to identify the predictor variables associated with the disclosure of HIV-positive status among pregnant women to their sexual partners. Finally, the adjusted odds ratio with 95% confidence intervals at P-value< 0.05 was considered statistically significant. Results Of the total, 135 (86.5%) of HIV-positive pregnant women disclosed their HIV status to their sexual partner. Christian followers (both Orthodox and Protestant) [AOR = 8.8, 95% CI: 2.3. 34] more likely to disclose HIV status to their sexual partner than those Muslims. Those participants who started practicing safer sex [AOR = 17.6, 95% CI: 4–77] and those women who had a smooth relationship before the HIV disclosure were [AOR = 14.7, 95% CI: 3–68.6] more likely to disclose HIV status to their sexual partner than their counterparts, respectively. Conclusions The proportion of HIV serostatus disclosure by HIV-positive pregnant women attending antenatal care services to their sexual partners was encouraging. However, this does not mean that there is no need for further awareness and intervention. Hence, interventions to boost and support women in safely disclosing their HIV-positive status are needed.
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Affiliation(s)
- Mulusew Ambissa
- Black Lion Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Endalew Gemechu Sendo
- School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yeshi Assefa
- School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemu Guta
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
- * E-mail:
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21
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Yalew M, Adane B, Kefale B, Damtie Y, Tadesse SE, Molla A. The effect of counseling, antiretroviral therapy and relationship on disclosing HIV positive status to sexual partner among adult HIV patients in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0249887. [PMID: 33886583 PMCID: PMC8061922 DOI: 10.1371/journal.pone.0249887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) is continued as a major public health problem, especially in developing countries. Therefore, this study aimed to estimate the effect of counseling, antiretroviral therapy (ART) and relationship on disclosing HIV positive status to sexual partner among adult HIV patients in Ethiopia. METHODS The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was used during this review. The study included both published and unpublished studies which were conducted in Ethiopia until the end of 2019. Different electronic databases (PubMed, Cochrane library, CINAHL, Global Health, HINARI and Google scholar) were searched. Data were extracted in Microsoft Excel sheet and STATA/SE 14 was used to meta-analysis. I2 and Egger test statistics were used to test heterogeneity and publication bias respectively. RESULTS Twenty-two articles with 8,873 adult HIV infected peoples were included in this systematic review and meta-analysis. The pooled magnitude of disclosing HIV status to sexual partner was 74.63% [95% CI: (67.79, 81.47)]. Counseled [AOR = 4.96, 95% CI: (2.87, 8.55)], ART initiated [AOR = 4.78, 95% CI: (3.84, 5.94)] and who had a smooth relationship before HIV testing [AOR = 6.82, 95% CI: (3.49, 13.33)] were significantly associated with disclosing HIV status to sexual partner. CONCLUSIONS Disclosing HIV positive status to sexual partner in Ethiopia was low as the government invested in partner notification. Counseling, ART initiation and smooth relationship before HIV testing were significantly associated with disclosing HIV status to sexual partner. The government needs to strengthen pre and post HIV test counseling even after treatment started to increase disclosing status. REGISTRATION The protocol of this systematic review and meta-analysis was registered in the PROSPERO with a specific registration number: CRD42020161276; https://clinicaltrials.gov/.
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Affiliation(s)
- Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Eshete Tadesse
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asressie Molla
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Biomndo BC, Bergmann A, Lahmann N, Atwoli L. Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV-positive women: Evidence from government facilities in Kenya. PLoS One 2021; 16:e0249813. [PMID: 33882084 PMCID: PMC8059826 DOI: 10.1371/journal.pone.0249813] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV's association with poor ART adherence. We investigate this association among a broad group of women. METHODS We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using the Visual Analogue Scale (VAS); responses were dichotomised at a ≥95% cut-off. Multiple logistic regression models assessed the association between the independent variables and ART adherence. RESULTS The participants' mean age was 38.6 (range: 18-69 years). The majority had ever attended school (94%, n = 382), were in monogamous marriages (70%, n = 282), and had disclosed status to partners (94%, n = 380). Overall, 60% (n = 242) reported optimal ART adherence (≥ 95%) in the previous 30 days. The prevalence of IPV by the current partner was 76% (CI95 = 72-80%). Experiencing physical IPV (AOR 0.57, CI95: 0.34-0.94, p = .028), sexual IPV (AOR 0.50, CI95: 0.31-0.82, p = .005), or controlling behaviour (AOR 0.56, CI95: 0.34-0.94, p = .027) reduced the odds of achieving optimal adherence, while a higher education level and having an HIV-positive partner increased the odds. CONCLUSION IPV is common and is associated with suboptimal ART adherence rates among a broad group of HIV-positive women. ART programs could consider incorporating basic IPV interventions into regular clinic services to identify, monitor and support exposed women, as they might be at risk of poor ART adherence. Still, there is need for more research on how IPV affects ART adherence.
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Affiliation(s)
- Bornice C. Biomndo
- Institute of Health and Nursing Science, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | - Nils Lahmann
- Clinic for Geriatrics and Geriatric Medicine, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
- Medical College East Africa, Aga Khan University, Nairobi, Kenya
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Goodwin T, Gregson S, Maswera R, Moorhouse L, Nyamukapa C. Understanding the determinants and consequences of HIV status disclosure in Manicaland, Zimbabwe: cross-sectional and prospective analyses. AIDS Care 2021; 33:1577-1594. [PMID: 33813969 DOI: 10.1080/09540121.2021.1883507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Few longitudinal studies have measured trends and effects of disclosure over ART scale-up in general-population samples. We investigated levels, determinants and outcomes of disclosure to relatives and partners in a large general-population cohort in Zimbabwe. Trends in disclosure levels from 2003 to 2013 were analysed, and multivariable logistic regression was used to identify determinants. Longitudinal analyses were conducted testing associations between disclosure and prevention/treatment-related outcomes. Disclosure to anyone increased from 79% to 100% in men and from 63% to 98% in women from 2003 to 2008; but declined to 89% in both sexes in 2012-2013. More women than men disclosed to relatives (67.8% versus 44.4%; p < 0.001) but fewer women disclosed to partners (85.3% versus 95.0%; p < 0.001). In 2012-2013,secondary/higher education, being single, and experience of stigma were associated with disclosure to relatives in both sexes. Partner characteristics and HIV-group attendance were associated with disclosure to partners for women. Reactions to disclosure were generally supportive but less so for females than males disclosing to partners (92.0% versus 97.4%). Partner disclosure was weakly associated (p < 0.08) with having had a CD4 count or taken ART at follow-up in females. To conclude, this study shows disclosure is vital to HIV prevention and treatment, and programmes to facilitate disclosure should be re-invigorated.
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Affiliation(s)
| | - Simon Gregson
- Imperial College London, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | - Constance Nyamukapa
- Imperial College London, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
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Tolossa T, Wakuma B, Besho M, Mulisa D, Fekadu G, Bayisa L, Tsegaye R. HIV serostatus disclosure and associated factors among HIV positive pregnant and lactating women at Nekemte public health facilities, western Ethiopia. PLoS One 2021; 16:e0248278. [PMID: 33739992 PMCID: PMC7978369 DOI: 10.1371/journal.pone.0248278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 02/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Disclosure of Human Immune Virus (HIV) serostatus by pregnant and lactating women is crucial for the successful prevention of mother to child transmission of HIV/AIDS. However, little has been studied regarding the prevalence and factors associated with HIV status disclosure among HIV positive pregnant and lactating women in Ethiopia. METHODS An institution-based cross-sectional study was conducted in the Nekemte Public Health facilities among 380 pregnant and lactating women enrolled in universal antiretroviral therapy (ART) treatment from January 2015-December, 2019. The data were collected by using a checklist, developed from Prevention of Mother to Child Transmission (PMTCT) logbook, ART intake forms, and medical cards of the patients. Epidata version 3.2 was used for data entry, and then the data were exported to STATA version 14 for further analysis. The binary logistic regression model was employed to determine factors associated with the disclosure status among HIV positive pregnant and lactating women. Adjusted Odds Ratio (AOR) with 95% confidence intervals was computed and statistical significance was declared when it is significant at a 5% level (p-value < 0.05). RESULTS A total of 380 women have participated in the study. Two hundred seventy-six (73.4%) of women had disclosed their HIV status to at least one individual. The study found living in urban (OR = 1.83, 95% CI: 1.04, 3.20), married women (OR = 4.16, 95% CI: 1.87, 9.24), higher educational status (OR = 2.35, 95% CI: 1.31, 5.51), positive HIV status of partner (OR = 2.35, 95%CI: 1.17, 4.70), and being multipara (OR = 4.94, 95% CI: 2.29, 10.66) were independent determinants of HIV status disclosure. CONCLUSIONS HIV status disclosure among pregnant and lactating women in the study area was sub-optimal. Empowering women through education, encouraging partners for HIV testing, and enhancing active male involvement in HIV treatment and control programs should get due attention.
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Affiliation(s)
- Tadesse Tolossa
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Merga Besho
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ginenus Fekadu
- School of Pharmacy, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Lami Bayisa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Reta Tsegaye
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
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Jiang W, Osborn L, Drake AL, Unger JA, Matemo D, Kinuthia J, John-Stewart G, Ronen K. Recent Diagnosis, Lower Rates of HIV Disclosure, and High Technology Access in Pregnant Adolescent Girls and Young Women Living With HIV: A Descriptive Study. J Assoc Nurses AIDS Care 2021; 32:205-213. [PMID: 33136655 PMCID: PMC7985848 DOI: 10.1097/jnc.0000000000000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Wenwen Jiang
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Lusi Osborn
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Alison L. Drake
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jennifer A. Unger
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Daniel Matemo
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Keshet Ronen
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
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Masiano S, Machine E, Mphande M, Markham C, Tembo T, Chitani M, Mkandawire A, Mazenga A, Ahmed S, Kim M. Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041737. [PMID: 33579047 PMCID: PMC7916796 DOI: 10.3390/ijerph18041737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Abstract
VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.
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Affiliation(s)
- Steven Masiano
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Correspondence: (S.M.); (M.K.)
| | - Edwin Machine
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Mtisunge Mphande
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Christine Markham
- Center for Health Promotion and Preventive Research, Department of Health Promotion and Behavioral Sciences, The University of Texas, Houston, TX 77030, USA;
| | - Tapiwa Tembo
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Mike Chitani
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Angella Mkandawire
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Alick Mazenga
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Saeed Ahmed
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Section of Retrovirology and Global Health, Baylor College of Medicine, Houston, TX 77030, USA
| | - Maria Kim
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Section of Retrovirology and Global Health, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: (S.M.); (M.K.)
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Abbamonte JM, Parrish MS, Lee TK, Ramlagan S, Sifunda S, Peltzer K, Weiss SM, Jones DL. Influence of Male Partners on HIV Disclosure Among South African Women in a Cluster Randomized PMTCT Intervention. AIDS Behav 2021; 25:604-614. [PMID: 32892297 PMCID: PMC10174224 DOI: 10.1007/s10461-020-03021-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Disclosure of HIV serostatus is beneficial for women, their partners, and their infants as it enables women to actively participate in preventative care (Hodgson et al. in PLoS ONE 9(11):e111421, 2014; Odiachi et al. in Reprod Health 15(1):36, 2018). Therefore, it is important that interventions addressing HIV prevention include elements that foster disclosure of HIV to partners. This study conducted in South Africa utilizes the "Protect Your Family" (PYF) behavioral intervention and compares Prevention of Mother to Child Transmission (PMTCT) among women participating in the program versus those in a control program. Within both groups, male partners were either present or not present for the intervention. The purpose of this study was to examine differential disclosure over time for individuals in the different conditions and partner involvement. A firth logistic regression revealed an interaction in the experimental condition with male partners participating (b = - 2.84, SE = 1.56, p = .012), in which female participants were less likely to disclose their HIV status over time. Findings from this study illustrate that additional efforts are needed to empower women to disclose their HIV status.
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Affiliation(s)
- John M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | | | - Tae K Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Shandir Ramlagan
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Sibusiso Sifunda
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Karl Peltzer
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
- Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
- Department of Psychology, University of the Free State, Bloemfontain, South Africa
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404, 1400 NW 10th Avenue, Miami, FL, 33136, USA.
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Sao SS, Knettela BA, Kisigo GA, Knippler ET, Osaki H, Mwamba RN, Rogathi J, Ngochob JS, Mmbaga BT, Watt MH. HIV Community-Level Stigmatizing Attitudes in Tanzania: Perspectives from Antenatal Care. East Afr Health Res J 2020; 4:118-127. [PMID: 34308229 PMCID: PMC8279189 DOI: 10.24248/eahrj.v4i2.635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 11/19/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Stigma significantly impacts retention in HIV care and quality of life among people living with HIV. This study explored community-level HIV stigma from the perspective of patients and healthcare workers in antenatal care (ANC) in Moshi, Tanzania. METHODS We conducted in-depth interviews with 32 women (20 living with HIV), key-informant interviews with 7 ANC clinic employees, and two focus group discussions with 13 community health workers. RESULTS Themes emerged related to drivers and manifestations of stigma, resilience to stigmatizing attitudes, and opportunities to address stigma in ANC. Drivers of stigma included a fear of infection through social contact and associations of HIV with physical weakness (e.g., death, sickness) and immoral behaviour (e.g., sexual promiscuity). Manifestations included gossip, physical and social isolation, and changes in intimate relationships. At the same time, participants identified people who were resilient to stigmatizing attitudes, most notably individuals who worked in healthcare, family members with relevant life experiences, and some supportive male partners. CONCLUSION/RECOMMENDATIONS Supportive family members, partners, and healthcare workers can serve as role models for stigma-resilient behaviour through communication platforms and peer programs in ANC. Manifestations of HIV stigma show clear links to constructs of sexuality, gender, and masculinity, which may be particularly impactful during pregnancy care. The persistence of stigma emphasizes the need for innovation in addressing stigmatizing attitudes in the community. Campaigns and policies should go beyond dispelling myths about HIV transmission and immorality to innovate peer-led and couples-based stigma reduction programming in the ANC space.
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Affiliation(s)
- Saumya S Sao
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Godfrey A Kisigo
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Elizabeth T Knippler
- Duke Global Health Institute, Duke University, Durham, NC, USA
- GillingsSchool of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Haika Osaki
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Rimel N Mwamba
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jane Rogathi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - James S Ngochob
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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Price JT, Mabula-Bwalya CM, Freeman BL, Carda-Auten J, Phiri WM, Chibwe K, Kantumoya P, Vwalika B, Stringer JSA, Golin CE. Acceptability of a trial of vaginal progesterone for the prevention of preterm birth among HIV-infected women in Lusaka, Zambia: A mixed methods study. PLoS One 2020; 15:e0238748. [PMID: 32970697 PMCID: PMC7514015 DOI: 10.1371/journal.pone.0238748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/21/2020] [Indexed: 11/18/2022] Open
Abstract
Antenatal progesterone prevents preterm birth (PTB) in women with a short cervix or prior PTB in daily vaginal or weekly injectable formulations, respectively. Neither has been tested for the indication of maternal HIV, which is associated with an elevated risk of PTB. The Vaginal Progesterone (VP) Trial was a pilot feasibility study of VP to prevent HIV-related PTB in Lusaka, Zambia. Using mixed methods, we concurrently evaluated the acceptability of the trial and the study product among participants. Over a 1-year period, we enrolled 140 pregnant women living with HIV into a double-masked, placebo-controlled, randomized trial of daily self-administered VP or placebo. We administered an endline questionnaire to all participants and conducted in-depth interviews with 30 participants to assess barriers and facilitators to uptake and retention in the trial and to study product adherence. All interviews were audiotaped, transcribed, translated into English as needed, and independently coded by two analysts to capture emerging themes. Of 131 participants who completed the questionnaire, 128 (98%) reported that nothing was difficult when asked the hardest part about using the study product. When given a hypothetical choice between vaginal and injectable progesterone, 97 (74%) chose vaginal, 31 (24%) injectable, and 3 (2%) stated no preference. Most interviewees reported no difficulties with using the study product; others cited minor side effects and surmountable challenges. Strategies that supported adherence included setting alarms, aligning dosing with antiretrovirals, receiving encouragement from friends and family, sensing a benefit to their unborn baby, and positive feedback from study staff. Participants who reported preference of a vaginal medication over injectable described familiarity with the vaginal product, a fear of needles and resulting pain, and inconvenience of a weekly clinic visit. Those who would prefer weekly injections cited fewer doses to remember. Perceived barriers to study participation included mistrust about the motivations behind research, suspicion of Satanism, and futility or possible harm from a placebo. We report key influences on acceptability of a randomized trial of VP to prevent PTB among HIV-infected women in Zambia, which should inform methods to promote uptake, adherence, and retention in a full-scale trial.
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Affiliation(s)
- Joan T. Price
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | | | - Bethany L. Freeman
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jessica Carda-Auten
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | | | | | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Jeffrey S. A. Stringer
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Carol E. Golin
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Lifson AR, Workneh S, Hailemichael A, MacLehose RF, Horvath KJ, Hilk R, Sites A, Shenie T. Disclosure of HIV status among patients new to HIV care in Southern Ethiopia: role of perceived social support and other factors. AIDS Care 2020; 33:1133-1138. [PMID: 32613851 DOI: 10.1080/09540121.2020.1785999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reports from Sub-Saharan Africa, with a large HIV-infected population, vary widely in how often HIV status is disclosed to others, including spouses and other partners. We surveyed 1799 Ethiopian HIV patients newly enrolled in care within the previous 3 months at one of 32 local hospitals and health centers about disclosure of HIV status and two perceived social support domains: emotional/informational (EI) and tangible assistance (TA) support. Disclosure to another person was reported by 1389 (77%) persons. Disclosure rates to specific persons were: spouses or other partners = 74%; mothers = 24%; fathers = 16%; children = 26%; other family members = 37%; friends = 19%, and neighbors/other community members = 13%. Disclosure to another person was associated with higher social support scores on both EI and TA domains, marriage, and a longer time knowing HIV status. In multivariate adjusted models, disclosure to any person, as well as disclosure specifically to a spouse or partner, were associated with higher EI and higher TA social support scores. Provision of knowledgeable and emotionally supportive assistance can be an important factor in facilitating HIV disclosure. Helping persons with HIV decide who to disclose to and how to do so in the most positive manner is an essential component of HIV care and support.
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Affiliation(s)
- Alan R Lifson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Sale Workneh
- National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
| | - Abera Hailemichael
- National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Rose Hilk
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Anne Sites
- National Alliance of State and Territorial AIDS Directors, Global Program, Washington DC, USA
| | - Tibebe Shenie
- National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
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Payán DD, Derose KP, Fulcar MA, Farías H, Palar K. "It Was as Though My Spirit Left, Like They Killed Me": The Disruptive Impact of an HIV-Positive Diagnosis among Women in the Dominican Republic. J Int Assoc Provid AIDS Care 2020; 18:2325958219849042. [PMID: 31109213 PMCID: PMC6748475 DOI: 10.1177/2325958219849042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
An HIV diagnosis may be associated with severe emotional and psychological distress,
which can contribute to delays in care or poor self-management. Few studies have explored
the emotional, psychological, and psychosocial impacts of an HIV diagnosis on women in
low-resource settings. We conducted in-depth interviews with 30 women living with HIV in
the Dominican Republic. Interviews were audio-recorded, transcribed, and analyzed using
the biographical disruption framework. Three disruption phases emerged (impacts of a
diagnosis, postdiagnosis turning points, and integration). Nearly all respondents
described the news as deeply distressful and feelings of depression and loss of self-worth
were common. Several reported struggling with the decision to disclose—worrying about
stigma. Postdiagnosis turning points consisted of a focus on survival and motherhood;
social support (family members, friends, HIV community) promoted integration. The findings
suggest a need for psychological resources and social support interventions to mitigate
the negative impacts of an HIV diagnosis.
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Affiliation(s)
- Denise Diaz Payán
- 1 Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA, USA.,2 RAND Corporation, Santa Monica, CA, USA
| | | | - María Altagracia Fulcar
- 3 United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic
| | - Hugo Farías
- 4 United Nations World Food Programme, Regional Office for Latin America and the Caribbean, Panamá, Dominican Republic
| | - Kartika Palar
- 5 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Odiachi A, Sam-Agudu NA, Erekaha S, Isah C, Ramadhani HO, Swomen HE, Charurat M, Cornelius LJ. A mixed-methods assessment of disclosure of HIV status among expert mothers living with HIV in rural Nigeria. PLoS One 2020; 15:e0232423. [PMID: 32353036 PMCID: PMC7192376 DOI: 10.1371/journal.pone.0232423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022] Open
Abstract
Background Peer support provided by experienced and/or trained “expert” women living with HIV has been adopted by prevention of mother-to-child transmission of HIV (PMTCT) programs across sub-Saharan Africa. While there is ample data on HIV status disclosure among non-expert women, there is little data on disclosure among such expert women, who support other women living with HIV. Objective This study compared HIV disclosure rates between expert and non-expert mothers living with HIV, and contextualized quantitative findings with qualitative data from expert women. Methods We compared survey data on HIV disclosure to male partners and family/friends from 37 expert and 100 non-expert mothers living with HIV in rural North-Central Nigeria. Four focus group discussions with expert mothers provided further context on disclosure to male partners, extended family and peers. Chi square and Fisher’s exact tests were applied to quantitative data. Qualitative data were manually analyzed using a Grounded Theory approach. Results Two-thirds of the 137 participants were 21–30 years old; 89.8% were married, and 52.3% had secondary-level education. Disclosure to male partners was higher among expert (100.0%) versus non-expert mothers (85.0%), p = 0.035. Disclosure to anyone (93.1% vs 80.8%, p = 0.156), and knowledge of male partners’ HIV status were similar (75.7% versus 66.7%, p = 0.324) between expert and non-expert mothers, respectively. With respect to male partners, HIV serodiscordance rates were also similar (46.4% vs 55.6%, p = 0.433). Group discussions indicated that expert mothers did not consistently disclose to their mentored clients, with community-level stigma and discrimination stated as major reasons for this non-disclosure. Conclusions Expert mothers experience similar disclosure barriers as their non-expert peers, especially regarding disclosure outside of intimate relationships. Thus, attention to expert mothers’ coping skills and disclosure status, particularly to mentored clients is important to maximize the impact of peer support in PMTCT. Clinical trials registration Clinicaltrials.gov registration number NCT 01936753 (retrospective), September 3, 2013.
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Affiliation(s)
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Salome Erekaha
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Christopher Isah
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Habib O. Ramadhani
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Homsuk E. Swomen
- Sexual, Reproductive Health and Gender Unit, United Nations Population Fund, Abuja, Nigeria
| | - Manhattan Charurat
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Llewellyn J. Cornelius
- School of Social Work and College of Public Health, University of Georgia Athens, Athens, Georgia, United States of America
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Nordberg B, Gabriel EE, Were E, Kaguiri E, Ekström AM, Kågesten A, Rautiainen S. Social concerns related to HIV status disclosure and participation in the prevention of mother-to-child transmission of HIV care among pregnant women in Kenya. BMC Pregnancy Childbirth 2020; 20:225. [PMID: 32299386 PMCID: PMC7164265 DOI: 10.1186/s12884-020-02907-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background Social concerns about unintentional HIV status disclosure and HIV-related stigma are barriers to pregnant women’s access to prevention of mother-to-child transmission of HIV (PMTCT) care. There is limited quantitative evidence of women’s social and emotional barriers to PMTCT care and HIV disclosure. We aimed to investigate how social concerns related to participation in PMTCT care are associated with HIV status disclosure to partners and relatives among pregnant women living with HIV in western Kenya. Methods A cross-sectional study, including 437 pregnant women living with HIV, was carried out at enrolment in a multicentre mobile phone intervention trial (WelTel PMTCT) in western Kenya. Women diagnosed with HIV on the day of enrolment were excluded. To investigate social concerns and their association with HIV disclosure we used multivariable-adjusted logistic regression, adjusted for sociodemographic and HIV-related characteristics, to estimate odds ratios (OR) and 95% confidence intervals (CI). Results The majority (80%) had disclosed their HIV status to a current partner and 46% to a relative. Older women (35–44 years) had lower odds of disclosure to a partner (OR = 0.15; 95% CI: 0.05–0.44) compared to women 18–24 years. The most common social concern was involuntary HIV status disclosure (reported by 21%). Concern about isolation or lack of support from family or friends was reported by 9%, and was associated with lower odds of disclosure to partners (OR = 0.33; 95% CI: 0.12–0.85) and relatives (OR = 0.37; 95% CI: 0.16–0.85). Concern about separation (reported by 5%; OR = 0.17; 95% CI: 0.05–0.57), and concern about conflict with a partner (reported by 5%; OR = 0.18; 95% CI: 0.05–0.67), was associated with lower odds of disclosure to a partner. Conclusions Compared to previous reports from Kenya, our estimated disclosure rate to a partner is higher, suggesting a possible improvement over time in disclosure. Younger pregnant women appear to be more likely to disclose, suggesting a possible decreased stigma and more openness about HIV among younger couples. Healthcare providers and future interventional studies seeking to increase partner disclosure should consider supporting women regarding their concerns about isolation, lack of support, separation, and conflict with a partner. PMTCT care should be organized to ensure women’s privacy and confidentiality.
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Affiliation(s)
- Björn Nordberg
- Department of Global Public Health, Global and Sexual Health (GloSH), Karolinska Institutet, Stockholm, Sweden. .,Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden.
| | - Erin E Gabriel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Edwin Were
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | | | - Anna Mia Ekström
- Department of Global Public Health, Global and Sexual Health (GloSH), Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Kågesten
- Department of Global Public Health, Global and Sexual Health (GloSH), Karolinska Institutet, Stockholm, Sweden
| | - Susanne Rautiainen
- Department of Global Public Health, Global and Sexual Health (GloSH), Karolinska Institutet, Stockholm, Sweden.,Brigham and Women's Hospital, Boston, USA
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Ogbonnaya IN, Wanyenze RK, Reed E, Silverman JG, Kiene SM. Prevalence of and Risk Factors for Intimate Partner Violence in the First 6 Months Following HIV Diagnosis Among a Population-Based Sample in Rural Uganda. AIDS Behav 2020; 24:1252-1265. [PMID: 31538284 DOI: 10.1007/s10461-019-02673-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research in Uganda examining HIV-positive status disclosure and IPV victimization is scarce, and existing findings may not generalize to community-based samples of men and women newly diagnosed with HIV in Uganda. We investigated the prevalence of lifetime IPV, IPV experienced between HIV diagnosis and 6 months following diagnosis (recent IPV), and IPV specifically related to a partner learning one's HIV-positive status among a sample of men and women newly diagnosed with HIV in a population-based study in rural Uganda. We also examined correlates of recent IPV, including HIV-positive status disclosure. The sample included 337 participants followed for 6 months after HIV diagnosis. Lifetime IPV findings showed that over half of the sample reported experiencing emotional IPV (62.81% of men, 70.37% of women), followed by physical IPV (21.49% of men, 26.39% of women) then sexual IPV (7.44% of men, 17.59% of women). For recent IPV, men and women reported similar rates of physical (4.63% and 8.29%, respectively) and emotional (19.44% and 25.91%, respectively) IPV. Women were more likely than men to report recent sexual IPV (8.29% vs. 1.85%); however, this relationship was no longer significant after controlling for other risk factors associated with sexual IPV (AOR = 3.47, 95% CI [0.65, 18.42]). Participants who disclosed their HIV-positive status to their partner had 59% lower odds of reporting emotional IPV (AOR = 0.41, 95% CI [0.21, 0.81]) than participants who did not disclose their HIV-positive status. Younger age, non-polygamous marriage, lower social support, and greater acceptance for violence against women were also significantly associated with experience of recent IPV. Overall, 12.20% of participants who experienced recent IPV reported that the IPV was related to their partner learning their HIV-positive status. Findings highlight the need for IPV screening and intervention integrated into HIV diagnosis, care, and treatment services.
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Affiliation(s)
- Ijeoma Nwabuzor Ogbonnaya
- San Diego State University School of Social Work, San Diego, CA, USA
- Arizona State University School of Social Work, Phoenix, AZ, USA
| | | | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, San Diego State University School of Public Health, San Diego, CA, USA
| | - Jay G Silverman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California at San Diego School of Medicine, La Jolla, CA, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
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Testing Positive and Disclosing in Pregnancy: A Phenomenological Study of the Experiences of Adolescents and Young Women in Maseru, Lesotho. AIDS Res Treat 2020; 2020:6126210. [PMID: 32099675 PMCID: PMC7037533 DOI: 10.1155/2020/6126210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/13/2020] [Indexed: 12/03/2022] Open
Abstract
The routine antenatal screening through the prevention of mother to child transmission of HIV (PMTCT) services results in pregnancy being often the point at which an HIV diagnosis is made. Disclosure to partners presents particular complexities during pregnancy. However, research on the pattern and experiences of disclosure in pregnancy is limited in Lesotho, despite the high prevalence of HIV among pregnant women. The aim of this study was to explore and describe the disclosure experiences of adolescent girls and young women (AGYW) after receiving a positive HIV test result during pregnancy. Methods. Descriptive phenomenology using semistructured in-depth interview was used to collect data from AGYM sampled purposively from PMTCT sites located in urban areas of Maseru, Lesotho. Data analysis was inductive and followed the thematic approach. Findings. There were 15 AGYW involved in this study with the mean age of 20 years. Fourteen reported being pregnant with their first child and perceived HIV testing in antenatal care as compulsory. Ten AGYM disclosed their HIV status in the immediate posttesting period to protect their partners from HIV infection. The narratives revealed that the AGYM hoped that after disclosing, the partner would be tested for HIV. Furthermore, the AGYM disclosed because they wanted freedom to take their medication. Their experience of disclosure was relief, as they did not have to hide their HIV status. The AGYM reported being supported to adhere to medication and clinic attendance by their partners who also provided emotional support to them to deal with being HIV positive and pregnant. Conclusion. The AGYM recounted an overall positive experience of disclosure to their partners who agreed to test for HIV and adopted safe sex practices. This has positive implications for the PMTCT programme and the involvement of men in reproductive health. Therefore, there is need to integrate disclosure and partner testing interventions in the cascade of services in PMTCT programmes.
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Modi A, Kosambiya JK, Trivedi S, Chaudhari VP, Mehta A, Wells KJ. "My Life is Spoiled Because of Him…" A Qualitative Study of Human Immunodeficiency Virus Disclosure and Male Involvement in Prevention of Mother-to-Child Transmission Program. Indian J Community Med 2019; 44:322-327. [PMID: 31802793 PMCID: PMC6881897 DOI: 10.4103/ijcm.ijcm_366_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: India has the third largest human immunodeficiency virus (HIV) epidemic in the world, with 15,000 newborns infected every year. Prevention of mother-to-child transmission (PMTCT) services can eliminate new HIV infections. Nondisclosure of positive HIV status and nonoptimal uptake of PMTCT are related. Therefore, understanding different aspects of HIV disclosure are necessary for program managers and careproviders for prevention and support. Objective: The present research explores HIV disclosure narratives, the family's perspective, and theoretical framework in the context of PMTCT. Methods: A qualitative study was conducted among 31 (16 mothers and 15 fathers) utilizers of PMTCT at an urban antiretroviral therapy center. A semi-structured in-depth interview guide based on disclosure process model (DPM) was used to explore HIV disclosure goals and outcomes by both members of parental dyad. The recorded interviews were transcribed verbatim, translated into English, and analyzed with Atlas.ti software. Directed content analysis was used to code data according to “a priori” and emerging themes. Demographic data were analyzed using descriptive statistics. Results: Limited disclosure is a necessity for pregnant women and their male partners for approach coping with HIV diagnosis and pursuing positive support for PMTCT adherence. Interpersonal, society, and community contextual outcomes affect the care uptake and future likelihood of disclosure. Conclusions: DPM suggestions from the present study can be used to facilitate a goal-directed process that allows parents/PLWHA to selectively disclose their HIV status to family members and acquaintances for obtaining maximum support to eliminate newborn HIV infections while minimizing distress, stigma, and discrimination.
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Affiliation(s)
- Anjali Modi
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | | | - Sangita Trivedi
- Paediatrics, Government Medical College, Surat, Gujarat, India
| | - Vipul P Chaudhari
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Alap Mehta
- Art Center, New Civil Hospital, Surat, Gujarat, India
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, California, United States of America
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Luseno WK, Iritani BJ, Maman S, Mbai I, Ongili B, Otieno FA, Hallfors DD. "If the mother does not know, there is no way she can tell the adolescent to go for drugs": Challenges in promoting health and preventing transmission among pregnant and parenting Kenyan adolescents living with HIV. CHILDREN AND YOUTH SERVICES REVIEW 2019; 103:100-106. [PMID: 31308586 PMCID: PMC6628199 DOI: 10.1016/j.childyouth.2019.05.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Adolescents living with HIV (ALHIV) who are pregnant, or parenting, are an important but understudied group. This study explores the challenges in promoting the health of these adolescents and preventing onward transmission. We used existing semi-structured interview data from a 2014 study conducted among Kenyan ALHIV (ages 15-19), their family members, and local health staff to examine adolescent HIV-testing, disclosure, and treatment engagement, focusing on participants who were pregnant, had given birth, or had fathered a child. A total of 28 participant interviews were analyzed, including those conducted with nine ALHIV, four family members, and 15 HIV providers. Four adolescent participants were not in care at the time of their interview. Our analysis also included a transcript from a stakeholder meeting involving HIV providers and associated administrators, held to disseminate and garner feedback on, preliminary findings from the original study. Based on our analysis, adolescents frequently reported being alone during testing, experiencing fear and denial on receiving their results, and delaying disclosure to family and linkage to treatment. They also mentioned a lack of contraceptive counseling, with some reporting multiple pregnancies. Providers voiced misgivings and uncertainty about disclosing HIV diagnoses to minor adolescents without a family member present and reported severe shortages of personnel and resources to adequately serve ALHIV in rural clinics. These findings highlight gaps in services that limit adolescent engagement in HIV treatment prior to sexual debut and conceiving a child, and in PMTCT during and after pregnancy. Greater research attention is needed to address ALHIV reproductive health needs, improve linkage to HIV treatment, and prevent onward sexual transmission. Empirical ethics studies of current adolescent disclosure policies are also warranted to examine cultural and developmental appropriateness, and effectiveness in fostering support and engagement in HIV services.
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Affiliation(s)
- Winnie K. Luseno
- Pacific Institute for Research and Evaluation (PIRE), 101
Conner Dr., Ste 200, Chapel Hill, NC 27514, United States of America
| | - Bonita J. Iritani
- Pacific Institute for Research and Evaluation (PIRE), 101
Conner Dr., Ste 200, Chapel Hill, NC 27514, United States of America
| | - Suzanne Maman
- Department of Health Behavior and Health Education,
University of North Carolina, Chapel Hill 27599, United States of America
| | - Isabella Mbai
- College of Health Sciences, School of Nursing, Moi
University, P.O. Box 4606, Eldoret, Kenya
| | - Barrack Ongili
- Centre for Global Health Research, Kenya Medical Research
Institute (KEMRI), Busia Road, P.O. Box 1578, 40100 Kisumu, Kenya
| | - Florence Anyango Otieno
- Centre for Global Health Research, Kenya Medical Research
Institute (KEMRI), Busia Road, P.O. Box 1578, 40100 Kisumu, Kenya
| | - Denise Dion Hallfors
- Pacific Institute for Research and Evaluation (PIRE), 101
Conner Dr., Ste 200, Chapel Hill, NC 27514, United States of America
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Nyati-Jokomo Z, Chitsike I, Mbizvo E, January J. 'If nurses were in our shoes would they breastfeed their own babies?' A qualitative inquiry on challenges faced by breastfeeding mothers on the PMTCT programme in a rural community in Zimbabwe. BMC Pregnancy Childbirth 2019; 19:191. [PMID: 31146725 PMCID: PMC6543664 DOI: 10.1186/s12884-019-2336-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 05/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Prevention of Mother to Child Transmission (PMTCT) of HIV programme in Zimbabwe has had remarkable success despite the country's economic challenges. The aim of this study was to explore the challenges faced by breastfeeding mothers on the PMTCT programme. METHOD Narratives from 15 women (age range 19-35 years) were collected at two rural health facilities in Zimbabwe through in-depth interviews over a period of 6 months. Thematic analysis was used to describe breastfeeding mothers' experiences and challenges of being on the PMTCT programme. RESULTS The findings suggest that breastfeeding women on the PMTCT programme face challenges that include internal, external and institutional stigma and discrimination. Women reported a sense of powerlessness in decision making on following through with the PMTCT programme and were ambivalent regarding disclosure of their HIV status to their partners and significant others. CONCLUSION HIV and AIDS programmes should pay attention to women's readiness for interventions. There is need to understand women's life experiences to ensure informed and targeted programming for PMTCT.
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Affiliation(s)
- Zibusiso Nyati-Jokomo
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe
| | - Inam Chitsike
- Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe
| | - Elizabeth Mbizvo
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.
| | - James January
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe
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Bengtson AM, Go V, Kumwenda W, Lurie M, Kutengule A, Owino M, Hosseinipour M. "A way of escaping": a qualitative study exploring reasons for clinic transferring and its impact on engagement in care among women in Option B. AIDS Care 2019; 32:72-75. [PMID: 31067986 DOI: 10.1080/09540121.2019.1614521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Clinic transfers among women in Option B+ are frequent, often undocumented, and may lead to suboptimal engagement in care and HIV outcomes. The reasons women move between HIV clinics are not well understood. We conducted four focus group discussions (FGD) among HIV-infected pregnant women in Option B+ and four FGDs and five in-depth interviews among healthcare workers (HCWs) at two large ART clinics in Lilongwe, Malawi. Mobility and fear of inadvertent HIV disclosure, particularly due to seeing neighbors or acquaintances at a clinic, were key drivers of transferring between HIV clinics. Women were aware of the need to obtain a formal transfer, but in practice this was often not feasible and led women to self-transfer clinics. Self-transferring to a new clinic frequently resulted to re-testing and re-initiating ART and concerns about disruptions in ART. Strategies to monitor women's engagement in HIV care without requiring a formal transfer are urgently needed.
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Affiliation(s)
- Angela M Bengtson
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Vivian Go
- Department of Health Behavior, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | - Mark Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | | | - Michael Owino
- Department of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Mina Hosseinipour
- UNC Project-Malawi, Lilongwe, Malawi.,Department of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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40
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Marais A, Kuo CC, Julies R, Stein DJ, Joska JA, Zlotnick C. "If He's Abusing You . . . the Baby Is Going to Be Affected": HIV-Positive Pregnant Women's Experiences of Intimate Partner Violence. Violence Against Women 2019; 25:839-861. [PMID: 30298793 PMCID: PMC6456433 DOI: 10.1177/1077801218802640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pregnancy represents a time of increased risk for intimate partner violence (IPV), and an HIV diagnosis further increases the vulnerability of this at-risk group. This study explores experiences of recent IPV using qualitative interviews with N = 12 HIV-positive pregnant women recruited from a clinical setting in South Africa, a location with a high global prevalence of IPV and HIV. Partner dynamics around IPV resulted in HIV shame and stigma and adversely affected engagement in HIV care and HIV treatment behaviors. The results highlight the challenges women face in navigating disclosure of both IPV and HIV, accessing necessary support, and engaging in both HIV-related and pregnancy-related care in the context of an abusive relationship.
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Affiliation(s)
- Adele Marais
- 1 Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Caroline C Kuo
- 1 Department of Psychiatry and Mental Health, University of Cape Town, South Africa
- 2 Brown University, Providence, RI, USA
| | - Robin Julies
- 1 Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Dan J Stein
- 1 Department of Psychiatry and Mental Health, University of Cape Town, South Africa
- 3 SA MRC Unit on Risk and Resilience in Mental Disorders
| | - John A Joska
- 1 Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Caron Zlotnick
- 1 Department of Psychiatry and Mental Health, University of Cape Town, South Africa
- 4 The Warren Alpert Medical School of Brown University, Providence, RI, USA
- 5 Women & Infants Hospital, Providence, RI, USA
- 6 Butler Hospital, Providence, RI, USA
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Ngonzi J, Mugyenyi G, Kivunike M, Mugisha J, Salongo W, Masembe S, Mayanja R, Bajunirwe F. Frequency of HIV status disclosure, associated factors and outcomes among HIV positive pregnant women at Mbarara Regional Referral Hospital, southwestern Uganda. Pan Afr Med J 2019; 32:200. [PMID: 31312312 PMCID: PMC6620078 DOI: 10.11604/pamj.2019.32.200.12541] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/29/2018] [Indexed: 01/01/2023] Open
Abstract
Introduction Positive HIV results disclosure plays a significant role in the successful prevention and care of HIV infected patients. It provides significant social and health benefits to the individual and the community. Non-disclosure is one of the contextual factors driving the HIV epidemic in Uganda. Study objectives: to determine the frequency of HIV disclosure, associated factors and disclosure outcomes among HIV positive pregnant women at Mbarara Hospital, southwestern Uganda. Methods A cross-sectional study using quantitative and qualitative methods among a group of HIV positive pregnant women attending antenatal clinic was done and consecutive sampling conducted. Results The total participant recruitment was 103, of which 88 (85.4%) had disclosed their serostatus with 57% disclosure to their partners. About 80% had disclosed within less than 2 months of testing HIV positive. Reasons for disclosure included their partners having disclosed to them (27.3%), caring partners (27.3%) and encouragement by health workers (25.0%). Following disclosure, 74%) were comforted and 6.8% were verbally abused. Reasons for non-disclosure were fear of abandonment (33.3%), being beaten (33.3%) and loss of financial and emotional support (13.3%). The factors associated with disclosure were age 26-35 years (OR 3.9, 95% CI 1.03-15.16), primary education (OR 3.53, 95%CI 1.10-11.307) and urban dwelling (OR 4.22, 95% CI 1.27-14.01). Conclusion Participants disclosed mainly to their partners and were comforted and many of them were encouraged by the health workers. There is need to optimize disclosure merits to enable increased participation in treatment and support programs.
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Affiliation(s)
- Joseph Ngonzi
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Godfrey Mugyenyi
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Mukasa Kivunike
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Julius Mugisha
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Wasswa Salongo
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Sezalio Masembe
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Ronald Mayanja
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Francis Bajunirwe
- Mbarara University of Science and Technology, Department of Community Health, Uganda
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Chinaeke EE, Fan-Osuala C, Bathnna M, Ozigbu CE, Olakunde B, Ramadhani HO, Ezeanolue EE, Sam-Agudu NA. Correlates of reported modern contraceptive use among postpartum HIV-positive women in rural Nigeria: an analysis from the MoMent prospective cohort study. Reprod Health 2019; 16:2. [PMID: 30621714 PMCID: PMC6323844 DOI: 10.1186/s12978-018-0663-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background Nigeria has an annual population of ~ 200,000 women who are both pregnant and HIV-positive. High unmet need for family planning in this population could lead to unintended pregnancies, along with the increased risk of mother-to-child transmission of HIV (MTCT). To identify modifiable barriers and facilitators in effective family planning, we examined correlates of modern contraceptive use among HIV-positive women enrolled in the MoMent prevention of MTCT (PMTCT) implementation research study in rural North-Central Nigeria. Methods In this prospective cohort study, HIV-positive pregnant women were enrolled at 20 Primary Healthcare Centers and followed up to 12 months postpartum. Baseline socio-demographic, clinical and obstetric data were collected at enrollment. Participants were to receive routine family planning counselling from healthcare workers during postnatal visits. Analysis utilized baseline data linked to available family planning information collected from each woman at the first postpartum visit. Multivariate logistic regression was performed to determine factors associated with modern contraceptive use. Results Out of 497 women enrolled, family planning data was available for 399 (80.3%) women, of whom 349 (87.5%) received family planning counselling, and 321 (80.5%) were 30 years old or less. Two-thirds (268, 67.2%) of the cohort analyzed had 1–2 children at baseline; 24.8% (n = 99) had 3–4 children, and 8.0% (n = 32) had > 4 children. Approximately half (199, 49.9%) of the women reported no modern contraceptive use in the postpartum period. Male condoms (116, 29.1%) were the most reported method of contraception; other methods reported included oral hormones (71, 17.8%) and intrauterine devices (13, 3.2%). Only disclosure of HIV status to male partner or relative (aOR = 2.0, 95% CI: 1.2–3.3; p = 0.01) and receipt of family planning counselling (aOR = 2.3, 95% CI: 1.1–4.8; p = 0.03) were positively associated with reported modern contraceptive use. Age, marital or educational status, religious affiliation, employment status, gravidity and parity were non-correlates. Conclusions Family planning counselling and disclosure of HIV status are modifiable positive predictors of contraceptive use among our cohort of postpartum HIV-positive women in rural Nigeria. Rates of unintended pregnancy and concomitant risk of MTCT could be significantly reduced through strategies that facilitate these correlates. Clinical trials registration Clinicaltrials.gov registration number: NCT 01936753; registered September 3, 2013.
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Affiliation(s)
- Eric E Chinaeke
- Department of Clinical Pharmacy and Outcome Sciences, University of South Carolina College of Pharmacy, Columbia, USA
| | - Chinenye Fan-Osuala
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Miriam Bathnna
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Chamberline E Ozigbu
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Babayemi Olakunde
- School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.,National Agency for the Control of AIDS, Abuja, Nigeria
| | - Habib O Ramadhani
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Echezona E Ezeanolue
- Healthy Sunrise Foundation, Las Vegas, USA.,Department of Paediatrics and Child Health, University of Nigeria, Enugu, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria. .,Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.
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HIV Disclosure Among Pregnant Women Initiating ART in Cape Town, South Africa: Qualitative Perspectives During the Pregnancy and Postpartum Periods. AIDS Behav 2018; 22:3945-3956. [PMID: 30196332 DOI: 10.1007/s10461-018-2272-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
For women enrolled in prevention of mother-to-child transmission (PMTCT) programs, non-disclosure of their HIV status can be a significant barrier to sustained HIV care engagement. To explore decision-making surrounding HIV disclosure among HIV-infected pregnant women, we conducted repeated in-depth interviews during pregnancy and postpartum with 20 women recruited from a PMTCT clinic in Cape Town, South Africa. Three domains were examined using thematic analysis: (1) disclosure experiences, (2) challenges associated with partner disclosure, and (3) implications of nondisclosure. All women had disclosed to someone by the time of the baby's birth, typically limiting their disclosure to trusted individuals. Only half of participants disclosed to the father of the child. Nondisclosure, particularly to partners, was a significant source of worry and stress. Women used pregnancy as an explanation for using medication and attending frequent clinic appointments, and recognized impending challenges in the postpartum period when this excuse would no longer apply. Results suggest that PMTCT programs have a key role to play in helping individuals to make decisions about HIV disclosure, and assisting patients to navigate the disclosure process, especially with partners.
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Ramlagan S, Matseke G, Rodriguez VJ, Jones DL, Peltzer K, Ruiter RA, Sifunda S. Determinants of disclosure and non-disclosure of HIV-positive status, by pregnant women in rural South Africa. SAHARA J 2018; 15:155-163. [PMID: 30324859 PMCID: PMC6197005 DOI: 10.1080/17290376.2018.1529613] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Disclosure of HIV status remains one of the major challenges to the effectiveness of the prevention of mother to child transmission of HIV in rural areas in South Africa. This study aimed at assessing the determinants of HIV status disclosure among HIV infected pregnant women who have disclosed their HIV status to someone, as well as among those who have disclosed to their partners. Cross-sectional data was collected from 673 HIV sero-positive pregnant women receiving antenatal care services at 12 Community Health Centers in Mpumalanga province. Results indicated that over two-thirds (72.1%) disclosed their status to someone, while just over half (58.4%) disclosed to their partners. Multivariate analysis showed that both disclosure of ones HIV status to someone and to their male partners was significantly associated with increase in antiretroviral therapy (ART) adherence, the known HIV positive status of their partner, and male involvement during pregnancy. Participants who were diagnosed HIV positive during this current pregnancy were less likely to disclose their HIV status to someone. Non-disclosure during current pregnancy highlights a need for interventions that will encourage disclosure among HIV positive women, with a particular focus on those who are newly diagnosed. The findings also need to integrate male partner involvement and partner disclosure during pregnancy.
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Affiliation(s)
- Shandir Ramlagan
- HIV/Aids, STI and TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
- Department of Work & Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Gladys Matseke
- Department of Work & Social Psychology, Maastricht University, Maastricht, the Netherlands
- Research & Innovation Chief-Directorate, The National School of Government, Pretoria, South Africa
| | - Violeta J. Rodriguez
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Deborah L. Jones
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Karl Peltzer
- HIV/Aids, STI and TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
- Department of Research & Innovation, University of Limpopo, Sovenga, South Africa
| | - Robert A.C. Ruiter
- Department of Work & Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Sibusiso Sifunda
- HIV/Aids, STI and TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
- Department of Work & Social Psychology, Maastricht University, Maastricht, the Netherlands
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Knettel BA, Minja L, Chumba LN, Oshosen M, Cichowitz C, Mmbaga BT, Watt MH. Serostatus disclosure among a cohort of HIV-infected pregnant women enrolled in HIV care in Moshi, Tanzania: A mixed-methods study. SSM Popul Health 2018; 7:007-7. [PMID: 30560196 PMCID: PMC6289955 DOI: 10.1016/j.ssmph.2018.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/10/2018] [Accepted: 11/11/2018] [Indexed: 11/16/2022] Open
Abstract
HIV-infected pregnant women face complex decisions about whether and how to disclose their serostatus. Previous studies have shown that HIV disclosure is associated with better care engagement, emotional adjustment to the disease, and reduced risk of HIV transmission, but women face both real and perceived barriers to disclosure. We examined patterns and predictors of HIV disclosure in a cohort of 200 women diagnosed or confirmed to have HIV during antenatal care in the Kilimanjaro region of Tanzania and followed participants to three months postpartum. Twenty women also completed qualitative in-depth interviews during pregnancy and three months postpartum. During the pregnancy period (at least 30 days post-diagnosis), 79.5% of women had disclosed to at least one other person, with disclosures generally restricted to the father of the child and/or a small number of close family members. By three months postpartum, 11.9% of women had still not disclosed to anyone. Women who presented to antenatal care with an established HIV diagnoses and married women were more likely to report disclosures. Social support was positively associated with disclosure. In qualitative interviews, women pointed to community gossip and stigma as barriers to disclosure. Those who had not disclosed to the father of the child noted fears of abandonment during the vulnerable pregnancy period. Despite expressed fears, participants reported overall positive experiences of disclosure that led to increased support. Taken together, these results point to the need for comprehensive, flexible, and culturally informed interventions that assist pregnant and postpartum women in deciding when and how to disclose. Such interventions should acknowledge and explore common barriers to disclosure, including fears of public stigma and personal consequences. Given the strong associations between disclosure, social support, and community stigma, interventions for disclosure should be nested in broader efforts of public education and HIV stigma reduction.
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Affiliation(s)
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Lilian N Chumba
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Martha Oshosen
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Cody Cichowitz
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Johns Hopkins University School of Medicine, Baltimore, MD
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Hartmann M, Palanee-Phillips T, O'Rourke S, Adewumi K, Tenza S, Mathebula F, Wagner D, Ayub A, Montgomery ET. The relationship between vaginal ring use and intimate partner violence and social harms: formative research outcomes from the CHARISMA study in Johannesburg, South Africa. AIDS Care 2018; 31:660-666. [PMID: 30309246 DOI: 10.1080/09540121.2018.1533227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite being designed for autonomous use, research suggests partner approval is often in women's microbicide use. Microbicide study participants have described many ways product use affects relationships, from improving sexual pleasure to increasing harm, including exacerbating intimate partner violence (IPV). As the dapivirine ring proceeds closer to licensure, supporting women's agency to use microbicides safely is a priority. We conducted 42 in-depth interviews with former participants of the Microbicide Trials Network (MTN)-020 trial of the dapivirine vaginal ring and their male partners in Johannesburg, South Africa, to explore how ring use and partnership dynamics interacted. We sampled women who reported harms or partner non-support and women with supportive partners. Male and female narratives revealed high background levels of IPV. Women described how study participation/ring use exacerbated violence, and for a few couples served as a rationale for additional abuse. In response, women described feeling powerless and fearful of conflict, resulting in product nonuse. For one participant violence was reduced, and for several others, empowerment was sparked. These findings suggest future providers have the opportunity to shift more women from a place of fear/violence to one of safety/empowerment through the integration of IPV screening and relationship counselling.
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Affiliation(s)
- Miriam Hartmann
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | | | - Shannon O'Rourke
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | - Konyin Adewumi
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | - Siyanda Tenza
- b Wits Reproductive Health and HIV Institute , Johannesburg , South Africa
| | - Florence Mathebula
- b Wits Reproductive Health and HIV Institute , Johannesburg , South Africa
| | - Danielle Wagner
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | - Asha Ayub
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
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Fifield J, O'Sullivan L, Kelvin EA, Mantell JE, Exner T, Ramjee G, Blanchard K, Hoffman S. Social Support and Violence-prone Relationships as Predictors of Disclosure of HIV Status Among Newly Diagnosed HIV-positive South Africans. AIDS Behav 2018; 22:3287-3295. [PMID: 29744766 DOI: 10.1007/s10461-018-2136-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite the salience of social support and violence as potential outcomes of disclosure, how pre-existing social support and relationship violence among people living with HIV shapes and influences HIV status disclosure has received limited attention. Following the Disclosure Process Model, this study investigated pre-disclosure support and violence-prone relationships as predictors of disclosure using data from a prospective study of 459 newly diagnosed South African women and men. Most (88%) disclosed their status to at least one person by their 8-month interview. Level of social support was unrelated to disclosure to a partner. However, those with higher levels of support had higher odds of disclosing to family and to others. Women in violence-prone relationships were more likely to report disclosure to a partner than were those not in such relationships, counter to expectations. The findings suggest that the same mechanisms may not explain processes of disclosure across all relationship types.
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Affiliation(s)
- Jocelyn Fifield
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Ariadne Labs, Brigham and Women's Hospital and Harvard School of Public Health, Boston, MA, USA.
- , 401 Park Drive, Boston, MA, 02115, USA.
| | - Lucia O'Sullivan
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Elizabeth A Kelvin
- Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Theresa Exner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | | | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Winskell K, Kus L, Sabben G, Mbakwem BC, Tiéndrébéogo G, Singleton R. Social representations of mother-to-child transmission of HIV and its prevention in narratives by young Africans from five countries, 1997-2014: Implications for communication. Soc Sci Med 2018; 211:234-242. [PMID: 29966818 DOI: 10.1016/j.socscimed.2018.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 12/11/2022]
Abstract
International recommendations related to the prevention of mother-to-child transmission (PMTCT) of HIV have evolved rapidly over time; recommendations have also varied contextually in line with local constraints and national policies. This study examines how young Africans made sense of mother-to-child transmission (MTCT) and PMTCT and related barriers and facilitators between 1997 and 2014 in the context of these complex and changing recommendations. It uses a distinctive data source: 1343 creative narratives submitted to HIV-themed scriptwriting competitions by young people aged 10-24 from 5 African countries (Senegal, Burkina Faso, Nigeria, Kenya, and Swaziland) between 1997 and 2014. The study triangulates between analysis of quantifiable characteristics of the narratives, thematic qualitative analysis, and narrative-based approaches. MTCT occurs in 8% of the narratives (108), while it is prevented in 5% (65). Narratives differ according to whether they depict MTCT or PMTCT (or, rarely, both), evolve over time, and show cross-national thematic variation. In the aggregate, representations shift in line with increased access to testing and antiretroviral medications, with PMTCT narratives becoming more frequent and MTCT narratives becoming more hopeful as diagnosis becomes the gateway to ART access. However, storylines of intergenerational tragedy in which MTCT is depicted as inevitable persist through 2014. Alongside cross-national differences in theme and tone, narratives from higher prevalence Swaziland and Kenya situate MTCT/PMTCT more centrally within descriptions of life with HIV. Findings illustrate the need to improve communication about PMTCT, reframing negative cultural narratives to reflect the full promise of developments of the past decade and a half.
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Affiliation(s)
- Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Landy Kus
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Gaëlle Sabben
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Benjamin C Mbakwem
- Community and Youth Development Initiatives, Owerri, Imo State, Nigeria.
| | | | - Robyn Singleton
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
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Kinuthia J, Singa B, McGrath CJ, Odeny B, Langat A, Katana A, Ng'ang'a L, Pintye J, John-Stewart G. Prevalence and correlates of non-disclosure of maternal HIV status to male partners: a national survey in Kenya. BMC Public Health 2018; 18:671. [PMID: 29848345 PMCID: PMC5975408 DOI: 10.1186/s12889-018-5567-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevention of mother-to-child HIV transmission (PMTCT) programs usually test pregnant women for HIV without involving their partners. Non-disclosure of maternal HIV status to male partners may deter utilization of PMTCT interventions since partners play a pivotal role in decision-making within the home including access to and utilization of health services. METHODS Mothers attending routine 6-week and 9-month infant immunizations were enrolled at 141 maternal and child health (MCH) clinics across Kenya from June-December 2013. The current analysis was restricted to mothers with known HIV status who had a current partner. Multivariate logistic regression models adjusted for marital status, relationship length and partner attendance at antenatal care (ANC) were used to determine correlates of HIV non-disclosure among HIV-uninfected and HIV-infected mothers, separately, and to evaluate the relationship of non-disclosure with uptake of PMTCT interventions. All analyses accounted for facility-level clustering, RESULTS: Overall, 2522 mothers (86% of total study population) met inclusion criteria, 420 (17%) were HIV-infected. Non-disclosure of HIV results to partners was higher among HIV-infected than HIV-uninfected women (13% versus 3% respectively, p < 0.001). HIV-uninfected mothers were more likely to not disclose their HIV status to male partners if they were unmarried (adjusted odds ratio [aOR] = 3.79, 95% CI: 1.56-9.19, p = 0.004), had low (≤KSH 5000) income (aOR = 1.85, 95% CI: 1.00-3.14, p = 0.050), experienced intimate partner violence (aOR = 3.65, 95% CI: 1.84-7.21, p < 0.001) and if their partner did not attend ANC (aOR = 4.12, 95% CI: 1.89-8.95, p < 0.001). Among HIV-infected women, non-disclosure to male partners was less likely if women had salaried employment (aOR = 0.42, 95%CI: 0.18-0.96, p = 0.039) and each increasing year of relationship length was associated with decreased likelihood of non-disclosure (aOR = 0.90, 95% CI: 0.82-0.98, p = 0.015 for each year increase). HIV-infected women who did not disclose their HIV status to partners were less likely to uptake CD4 testing (aOR = 0.32, 95% CI: 0.15-0.69, p = 0.004), to use antiretrovirals (ARVs) during labor (OR = 0.38, 95% CI 0.15-0.97, p = 0.042), or give their infants ARVs (OR = 0.08, 95% CI 0.02-0.31, p < 0.001). CONCLUSION HIV-infected women were less likely to disclose their status to partners than HIV-uninfected women. Non-disclosure was associated with lower use of PMTCT services. Facilitating maternal disclosure to male partners may enhance PMTCT uptake.
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Affiliation(s)
- John Kinuthia
- Kenyatta National Hospital, P.O. Box 2590-00202, Nairobi, Kenya.
| | - Benson Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Agnes Langat
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Lucy Ng'ang'a
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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HIV Status Disclosure Among Postpartum Women in Zambia with Varied Intimate Partner Violence Experiences. AIDS Behav 2018; 22:1652-1661. [PMID: 28975510 DOI: 10.1007/s10461-017-1909-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
HIV-positive pregnant and postpartum women's status disclosure to male sexual partners is associated with improved HIV and maternal and child health outcomes. Yet, status disclosure remains a challenge for many women living with HIV in sub-Saharan Africa, particularly those who are fearful of violence. The objective of the present study is to advance the current understanding of the relationship between intimate partner violence against women and their HIV status disclosure behaviors. We specifically evaluate how the severity, frequency, and type of violence against postpartum HIV-positive women affect status disclosure within married/cohabiting couples. A cross-sectional survey was administered by trained local research assistants to 320 HIV-positive postpartum women attending a large public health center for pediatric immunizations in Lusaka, Zambia. Survey data captured women's self-reports of various forms of intimate partner violence and whether they disclosed their HIV status to the current male partner. Multiple logistic regression models determined the odds of status disclosure by the severity, frequency, and type of violence women experienced. Our findings indicate a negative dose-response relationship between the severity and frequency of intimate partner violence and status disclosure to male partners. Physical violence has a more pronounced affect on status disclosure than sexual or emotional violence. Safe options for women living with HIV who experience intimate partner violence, particularly severe and frequent physical violence, are urgently needed. This includes HIV counselors' ability to evaluate the pros and cons of status disclosure among women and support some women's decisions not to disclose.
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